p.17
Home Care and Treatment Instructions for Parents
What should be done if a child vomits after taking Artemether-Lumefantrine?
Repeat the dose if vomiting occurs within an hour.
p.22
Management of Respiratory Infections
What should be given if the child cannot breastfeed but can swallow?
Give expressed breast milk or a breast-milk substitute.
p.22
Management of Respiratory Infections
What to do if no nasogastric tube is available?
Give 1 teaspoon of sugar moistened with 1-2 drops of water sublingually and repeat every 20 minutes.
p.18
Nutritional Assessment and Management of Malnutrition
What should be noted about giving Iron to children with severe acute malnutrition?
They should not be given Iron if receiving ready-to-use therapeutic food (RUTF).
p.13
Nutritional Assessment and Management of Malnutrition
What is the routine worm treatment for children?
Mebendazole every 6 months from the age of one year.
p.22
Management of Respiratory Infections
What should be done if the child is not able to swallow?
Give 50 ml of milk or sugar water by nasogastric tube.
p.5
Assessment and Classification of Common Childhood Illnesses
What should you ask the mother during the assessment?
What the child's problems are.
p.2
Integrated Management of Childhood Illness (IMCI)
What is the main focus of the Integrated Management of Childhood Illness course?
To provide distance learning on child health management.
p.17
Home Care and Treatment Instructions for Parents
What is the dosing schedule for Artemether-Lumefantrine for a child weighing 5-<10 kg?
1 tablet twice daily for 3 days.
p.15
HIV Testing and Management in Children
What are the four stages of HIV infection according to WHO?
Stage 1: Asymptomatic, Stage 2: Mild Disease, Stage 3: Moderate Disease, Stage 4: Severe Disease (AIDS).
p.12
HIV Testing and Management in Children
What indicates a confirmed HIV infection in a child?
Positive virological test or positive serological test in a child 18 months or older.
p.23
Diarrhea and Dehydration Treatment Protocols
What is the recommended zinc dosage for a child aged 6 months or more?
1 tablet daily for 14 days.
p.23
Diarrhea and Dehydration Treatment Protocols
What should be done if a child vomits after taking ORS?
Wait 10 minutes, then continue more slowly.
p.16
HIV Testing and Management in Children
What is the dosage of Cotrimoxazole for a child less than 6 months?
2.5 ml of syrup once a day.
p.22
Management of Respiratory Infections
What should be done if the child is able to breastfeed?
Ask the mother to breastfeed the child.
p.3
General Danger Signs in Sick Children
What are the general danger signs in sick children?
Signs include difficulty breathing, persistent vomiting, and high fever.
p.2
General Danger Signs in Sick Children
What is covered in Module 1 of the course?
General danger signs for the sick child.
p.3
Management of Respiratory Infections
What is a key management strategy for respiratory infections in children?
Providing appropriate antibiotics when necessary.
p.12
HIV Testing and Management in Children
What action should be taken if the mother and child are not on ARV prophylaxis?
Test the mother and child.
p.15
HIV Testing and Management in Children
What characterizes Stage 1 of HIV infection?
No symptoms, or only persistent generalized lymphadenopathy (PGL).
p.12
HIV Testing and Management in Children
What should be done for a child who is HIV exposed?
Give cotrimoxazole prophylaxis and start or continue ARV prophylaxis.
p.9
Assessment and Classification of Common Childhood Illnesses
What should you ask to determine if a child has an ear problem?
Is there ear pain? Is there ear discharge?
p.7
Diarrhea and Dehydration Treatment Protocols
What should be done if a child has no dehydration?
Give fluid, zinc supplements, and food to treat diarrhea at home (Plan A).
p.10
Nutritional Assessment and Management of Malnutrition
What indicates severe acute malnutrition in terms of WFH/L and MUAC?
WFH/L less than -3 z-scores or MUAC less than 115 mm.
p.8
Fever Management and Malaria Risk Assessment
What treatment should be given for severe malaria?
First dose of artesunate or quinine.
p.3
Integrated Management of Childhood Illness (IMCI)
What is the purpose of Integrated Management of Childhood Illness (IMCI)?
To improve the health and survival of children under five years of age.
p.12
HIV Testing and Management in Children
What should be done if the mother is HIV positive and the child's status is negative or unknown?
Ask if the child was breastfeeding at the time or 6 weeks before the test.
p.2
Nutritional Assessment and Management of Malnutrition
What health issue is addressed in Module 6?
Malnutrition and anaemia.
p.15
HIV Testing and Management in Children
What symptoms are associated with Stage 2 of HIV infection?
Mild disease symptoms such as enlarged liver/spleen and skin conditions.
p.7
Diarrhea and Dehydration Treatment Protocols
What indicates some dehydration in a child?
Restless, irritable, sunken eyes, drinks eagerly, thirsty, skin pinch goes back slowly.
p.7
Diarrhea and Dehydration Treatment Protocols
What is the treatment for some dehydration?
Give fluid, zinc supplements, and food (Plan B).
p.15
HIV Testing and Management in Children
What is a key symptom that requires referral for diagnosis in HIV-infected children?
Conditions like severe acute malnutrition not responding to standard therapy.
p.19
Home Care and Treatment Instructions for Parents
What should be used to treat eye infections?
Tetracycline eye ointment.
p.14
HIV Testing and Management in Children
What do virological tests detect?
The presence of the HIV virus or its products in the blood.
p.14
HIV Testing and Management in Children
When can positive virological tests reliably detect HIV infection?
At any age, even before the child is 18 months old.
p.7
Diarrhea and Dehydration Treatment Protocols
What should be given for dysentery?
Ciprofloxacin for 3 days.
p.18
Nutritional Assessment and Management of Malnutrition
What is the duration for giving Iron to children at home?
One dose daily for 14 days.
p.5
Assessment and Classification of Common Childhood Illnesses
How do you determine if it's an initial or follow-up visit?
By checking if this is a follow-up visit for the problem.
p.11
Assessment and Classification of Common Childhood Illnesses
What action should be taken if some palmar pallor is observed?
Give iron and mebendazole if the child is 1 year or older.
p.19
Home Care and Treatment Instructions for Parents
What is the purpose of teaching the mother about treatment?
To ensure she understands the treatment and its importance.
p.8
Fever Management and Malaria Risk Assessment
What are the signs to look for in a child with fever?
Stiff neck, runny nose, signs of measles, and any bacterial cause of fever.
p.14
HIV Testing and Management in Children
What do serological tests detect?
Antibodies made by immune cells in response to HIV.
p.10
Nutritional Assessment and Management of Malnutrition
What is the first step in checking for acute malnutrition?
Look for signs of acute malnutrition and check for oedema of both feet.
p.10
Nutritional Assessment and Management of Malnutrition
What measurements are used to assess acute malnutrition in children 6 months or older?
Measure WFH/L z-score and MUAC in mm.
p.8
Fever Management and Malaria Risk Assessment
What indicates a very severe febrile disease?
Any general danger sign or stiff neck.
p.10
Nutritional Assessment and Management of Malnutrition
What should be done if a child with severe acute malnutrition has no medical complications?
Offer Ready-to-Use Therapeutic Food (RUTF) to eat.
p.8
Fever Management and Malaria Risk Assessment
What is the classification for a child with measles now or within the last 3 months?
Look for mouth ulcers and assess for complications.
p.16
Assessment and Classification of Common Childhood Illnesses
How should the appropriate drugs and dosages be determined?
Based on the child's age or weight.
p.19
Home Care and Treatment Instructions for Parents
What should the mother do after feeding if the child has thrush?
Wash breasts after feeds.
p.20
Immunization and Vitamin A Supplementation
Why is Vitamin A given to children?
To prevent deficiencies and support immune function.
p.2
Integrated Management of Childhood Illness (IMCI)
How many modules are included in the Integrated Management of Childhood Illness course?
15 booklets including various modules.
p.15
HIV Testing and Management in Children
What is the purpose of WHO Pediatric Staging for HIV Infection?
To monitor children and determine clinical response to ART treatment.
p.11
Assessment and Classification of Common Childhood Illnesses
What should be done if severe anaemia is detected?
Refer urgently to hospital.
p.13
Immunization and Vitamin A Supplementation
What vaccines are administered at 6 weeks?
DPT+HIB-1, OPV-1, Hep B1, RTV1, PCV1.
p.2
HIV Testing and Management in Children
What additional guide is provided for pediatric HIV?
Supplementary facilitator guide.
p.3
Home Care and Treatment Instructions for Parents
What home care instructions should be given to parents of sick children?
Encourage fluid intake and monitor for worsening symptoms.
p.13
Nutritional Assessment and Management of Malnutrition
What should be recorded on the child's chart?
The dose of Vitamin A and mebendazole given.
p.15
HIV Testing and Management in Children
What are some conditions that require a doctor's diagnosis in HIV-infected children?
Thrombocytopenia, neutropenia, and severe multiple bacterial infections.
p.11
Assessment and Classification of Common Childhood Illnesses
What should be assessed for if severe anaemia is suspected?
Assess for sickle cell anaemia if common in your area.
p.10
Nutritional Assessment and Management of Malnutrition
What classification is given to a child with complicated severe acute malnutrition?
Pink: COMPLICATED SEVERE ACUTE MALNUTRITION.
p.14
HIV Testing and Management in Children
What is the management for a child with a positive test who is not breastfeeding?
Manage as if they could be infected and repeat the test at 18 months.
p.21
Management of Respiratory Infections
What is the increased dose of Ampicillin for suspected meningitis?
The dose can be increased 4 times.
p.21
Management of Respiratory Infections
What is the dosage of Diazepam for a child weighing 5-7 kg?
0.5 ml of Diazepam (10mg/2ml).
p.17
Home Care and Treatment Instructions for Parents
Why should no child under 5 years be given an inhaler without a spacer?
To ensure effective delivery of the medication.
p.12
HIV Testing and Management in Children
What should be done if the child is not enrolled in HIV care?
Check for HIV infection using the provided chart.
p.5
Assessment and Classification of Common Childhood Illnesses
What age range does the assessment and classification of sick children cover?
From 2 months up to 5 years.
p.22
Management of Respiratory Infections
How do you make sugar water?
Dissolve 4 level teaspoons of sugar (20 grams) in a 200-ml cup of clean water.
p.17
Home Care and Treatment Instructions for Parents
What is the dosage of Paracetamol for a child aged 2 months up to 3 years?
1 tablet (100 mg) or 1/4 tablet (500 mg).
p.17
Home Care and Treatment Instructions for Parents
What should be done if a spacer is being used for the first time?
It should be primed by 4-5 extra puffs from the inhaler.
p.3
HIV Testing and Management in Children
What is the importance of HIV testing in children?
To identify and manage HIV-positive children early.
p.15
HIV Testing and Management in Children
What are some symptoms of Stage 3 HIV infection?
Recurrent severe bacterial pneumonia, pulmonary TB, and chronic HIV-associated lung diseases.
p.15
HIV Testing and Management in Children
What defines Stage 4 of HIV infection?
Severe disease (AIDS) with conditions like cryptococcal meningitis and HIV encephalopathy.
p.20
Immunization and Vitamin A Supplementation
What should always be recorded after giving Vitamin A?
The dose of Vitamin A given on the child's card.
p.15
HIV Testing and Management in Children
What is persistent generalized lymphadenopathy (PGL)?
A symptom characterized by swollen lymph nodes without other symptoms.
p.9
Management of Respiratory Infections
What is the immediate treatment for mastoiditis?
Give the first dose of an appropriate antibiotic and paracetamol for pain, then refer urgently to the hospital.
p.21
Management of Respiratory Infections
What equipment should be used for injections?
Use a sterile needle and sterile syringe.
p.10
Nutritional Assessment and Management of Malnutrition
What actions should be taken for a child classified as having uncomplicated severe acute malnutrition?
Give oral antibiotics for 5 days and RUTF, and counsel the mother on feeding.
p.8
Fever Management and Malaria Risk Assessment
What should be done if there are deep and extensive mouth ulcers?
Refer urgently to the hospital.
p.14
HIV Testing and Management in Children
What should be done for a breastfeeding child with a positive HIV test?
Manage as if they could be infected and repeat the test once breastfeeding has been discontinued for more than 6 weeks.
p.9
Assessment and Classification of Common Childhood Illnesses
What does it mean if there is no ear pain and no pus seen draining from the ear?
There is no ear infection.
p.6
Assessment and Classification of Common Childhood Illnesses
What should be counted to assess the child's breathing?
Count the breaths in one minute.
p.21
Management of Respiratory Infections
What is the maximum duration for quinine injections?
Do not continue quinine injections for more than 1 week.
p.6
Assessment and Classification of Common Childhood Illnesses
What is the follow-up recommendation if there are no signs of pneumonia or very severe disease?
Follow-up in 5 days if not improving.
p.1
Integrated Management of Childhood Illness (IMCI)
What is the focus of the March 2014 Chart Booklet?
Integrated Management of Childhood Illness.
p.17
Home Care and Treatment Instructions for Parents
How can a spacer be made at home?
By using a 500ml drink bottle, cutting a hole for the inhaler, and modifying it to fit the child's nose.
p.13
Immunization and Vitamin A Supplementation
What should be checked regarding a child's health during an assessment?
The child's immunization, vitamin A, and deworming status.
p.3
Diarrhea and Dehydration Treatment Protocols
What should be assessed in a child with diarrhea?
The level of dehydration.
p.7
Diarrhea and Dehydration Treatment Protocols
What should you ask to determine if a child has diarrhea?
Does the child have diarrhea? If yes, ask about the duration and if there is blood in the stool.
p.20
Immunization and Vitamin A Supplementation
When should an extra dose of Vitamin A be given?
If the child has measles or persistent diarrhea.
p.12
HIV Testing and Management in Children
What should be initiated upon confirming HIV infection?
Initiate ART treatment and HIV care.
p.5
Management of Respiratory Infections
What should be done if the child is convulsing now?
Give diazepam immediately.
p.11
Assessment and Classification of Common Childhood Illnesses
What should be assessed if the child is less than 2 years old and shows no palmar pallor?
Assess the child's feeding and counsel the mother.
p.5
Management of Respiratory Infections
What should be done to prevent low blood sugar in a sick child?
Treat to prevent low blood sugar.
p.21
Management of Respiratory Infections
What should be explained to the mother regarding the drug administration?
Explain why the drug is given to the child.
p.19
Home Care and Treatment Instructions for Parents
How often should quinolone eardrops be instilled?
Three times daily for two weeks.
p.19
Home Care and Treatment Instructions for Parents
What should be done for mouth ulcers?
Wash the mouth and apply half-strength gentian violet twice daily.
p.21
Management of Respiratory Infections
How should the dose be measured?
Measure the dose accurately.
p.6
Management of Respiratory Infections
What action should be taken if wheezing is present with fast breathing or chest indrawing?
Give a trial of rapid acting inhaled bronchodilator for up to three times, 15-20 minutes apart.
p.12
HIV Testing and Management in Children
What questions should be asked regarding HIV testing?
Has the mother or child had an HIV test?
p.13
Immunization and Vitamin A Supplementation
When should Vitamin A supplementation start for children?
At 6 months of age, given every six months.
p.3
Fever Management and Malaria Risk Assessment
What is the recommended treatment for fever in children?
Administering antipyretics and ensuring adequate hydration.
p.7
Diarrhea and Dehydration Treatment Protocols
What should be done if a child shows signs of severe dehydration?
Give fluid for severe dehydration (Plan C) or refer urgently to the hospital while giving frequent sips of ORS.
p.12
HIV Testing and Management in Children
What does a negative HIV test in the mother or child indicate?
HIV infection is unlikely.
p.9
Assessment and Classification of Common Childhood Illnesses
What indicates mastoiditis in a child?
Tender swelling behind the ear and pink coloration.
p.23
Diarrhea and Dehydration Treatment Protocols
What should be given to infants under 6 months who are not breastfed during ORS treatment?
100-200 ml of clean water.
p.14
HIV Testing and Management in Children
What should be done if a child under 18 months has a negative PCR test but has been breastfeeding?
This does not rule out infection; the child may have just become infected.
p.7
Diarrhea and Dehydration Treatment Protocols
What advice should be given for persistent diarrhea?
Advise on feeding, give multivitamins and minerals (including zinc) for 14 days, and follow-up in 5 days.
p.10
Nutritional Assessment and Management of Malnutrition
What does a yellow classification indicate in terms of nutritional status?
UNCOMPLICATED SEVERE ACUTE MALNUTRITION.
p.16
Home Care and Treatment Instructions for Parents
What should be explained to the mother before giving the drug?
The reason for giving the drug to the child.
p.9
Management of Respiratory Infections
What is the treatment for a chronic ear infection?
Dry the ear by wicking and treat with topical quinolone eardrops for 14 days.
p.21
Management of Respiratory Infections
What is the dosage of Gentamicin for children?
7.5 mg/kg/day once daily.
p.16
Home Care and Treatment Instructions for Parents
What should be done if more than one drug is prescribed?
Collect, count, and package each drug separately.
p.7
Diarrhea and Dehydration Treatment Protocols
What are the signs of severe dehydration in a child?
Lethargic or unconscious, sunken eyes, not able to drink or drinking poorly, skin pinch goes back very slowly.
p.8
Fever Management and Malaria Risk Assessment
What should be assessed first if a child has a fever?
Decide Malaria Risk: high or low.
p.2
Integrated Management of Childhood Illness (IMCI)
What is the purpose of the facilitator guide included in the course?
To assist facilitators in delivering the course content.
p.14
HIV Testing and Management in Children
Who is recommended to undergo HIV testing?
Children with unknown HIV status, especially those born to HIV-positive mothers.
p.13
General Danger Signs in Sick Children
What should be done for children with any general danger sign?
They should be referred after the first dose of an appropriate antibiotic and other urgent treatments.
p.23
Diarrhea and Dehydration Treatment Protocols
What should be done after 4 hours of ORS treatment?
Reassess the child and classify for dehydration.
p.8
Fever Management and Malaria Risk Assessment
What should be done if a malaria test is positive?
Give the recommended first line oral antimalarial and appropriate antibiotic treatment for any identified bacterial cause of fever.
p.5
Nutritional Assessment and Management of Malnutrition
What is the importance of keeping the child warm?
To prevent hypothermia and support recovery.
p.21
Management of Respiratory Infections
How should the dose of medication be determined?
Determine the dose appropriate for the child's weight or age.
p.16
Management of Respiratory Infections
What is the first step in treating a child according to the guidelines?
Carry out the treatment steps identified on the Assess and Classify chart.
p.9
Management of Respiratory Infections
What is the treatment for an acute ear infection?
Give an antibiotic for 5 days, paracetamol for pain, and dry the ear by wicking.
p.21
Management of Respiratory Infections
What should be done if referral is delayed for Ampicillin?
Repeat the ampicillin injection every 6 hours.
p.6
Assessment and Classification of Common Childhood Illnesses
What signs should be looked for during the assessment?
Chest indrawing, stridor, and wheezing.
p.6
Assessment and Classification of Common Childhood Illnesses
What is classified as fast breathing for a child aged 12 months to 5 years?
40 breaths per minute or more.
p.3
Nutritional Assessment and Management of Malnutrition
What nutritional assessment should be conducted for malnourished children?
Measuring weight-for-age and height-for-age.
p.5
Assessment and Classification of Common Childhood Illnesses
What are some questions to ask during the assessment?
Is the child able to drink or breastfeed? Does the child vomit everything? Has the child had convulsions?
p.3
Immunization and Vitamin A Supplementation
What vaccinations are essential for children?
Routine immunizations against diseases like measles, polio, and hepatitis.
p.5
General Danger Signs in Sick Children
What is the protocol for a child with any general danger sign?
Needs urgent attention; complete the assessment and any pre-referral treatment immediately.
p.12
HIV Testing and Management in Children
What should be done if the virological test is negative?
Repeat the test 6 weeks after breastfeeding has stopped.
p.19
Home Care and Treatment Instructions for Parents
What is the method for clearing the ear?
Dry wicking with a clean absorbent cloth or tissue paper.
p.7
Diarrhea and Dehydration Treatment Protocols
What is classified as severe persistent diarrhea?
Diarrhea lasting 14 days or more with dehydration present.
p.9
Assessment and Classification of Common Childhood Illnesses
What indicates an acute ear infection?
Pus draining from the ear for less than 14 days or ear pain.
p.16
Home Care and Treatment Instructions for Parents
What should be taught to the mother regarding oral drugs?
Teach the mother to give oral drugs at home.
p.9
Assessment and Classification of Common Childhood Illnesses
What indicates a chronic ear infection?
Pus draining from the ear for 14 days or more.
p.21
Management of Respiratory Infections
How should Ampicillin be prepared for injection?
Dilute a 500mg vial with 2.1ml of sterile water.
p.6
Assessment and Classification of Common Childhood Illnesses
What should you ask to determine if a child has respiratory issues?
Does the child have cough or difficult breathing?
p.16
Home Care and Treatment Instructions for Parents
What must be explained to the mother regarding the course of treatment?
All oral drug tablets or syrups must be used to finish the course of treatment, even if the child gets better.
p.6
Assessment and Classification of Common Childhood Illnesses
What should be done if coughing persists for more than 14 days?
Refer for possible TB or asthma assessment.
p.20
Nutritional Assessment and Management of Malnutrition
Under what conditions should Mebendazole be given?
If hookworm/whipworm are a problem, the child is 1 year or older, and has not had a dose in the previous 6 months.
p.19
Home Care and Treatment Instructions for Parents
What is the first step in treating an eye infection?
Clean both eyes with a clean cloth and water.
p.14
HIV Testing and Management in Children
Why is a positive serological test in children under 18 months not reliable?
Because HIV antibodies from the mother may still be present.
p.13
HIV Testing and Management in Children
What is the recommendation for HIV-positive children regarding vaccination?
They should not be vaccinated if they have symptoms consistent with HIV.
p.14
HIV Testing and Management in Children
What does a positive HIV antibody test result mean for children 18 months or older?
It means the child is infected.
p.19
Home Care and Treatment Instructions for Parents
What is the treatment for thrush?
Nystatin, instilled 1ml four times a day for 7 days.
p.10
Nutritional Assessment and Management of Malnutrition
What is the classification for a child with moderate acute malnutrition?
Yellow: MODERATE ACUTE MALNUTRITION.
p.21
Management of Respiratory Infections
What antibiotics should be given to children being referred urgently?
Give Ampicillin (50 mg/kg) and Gentamicin (7.5 mg/kg).
p.6
Assessment and Classification of Common Childhood Illnesses
What is the first step if a child has cough or difficult breathing?
Look, listen, feel and ask for how long.
p.8
Fever Management and Malaria Risk Assessment
What should be done if a child has measles with eye or mouth complications?
Give Vitamin A treatment and treat eye infection with tetracycline eye ointment if pus is draining from the eye.
p.16
Management of Respiratory Infections
What is the dosage of Amoxicillin for a child aged 12 months to 3 years?
2 tablets or 10 ml of syrup, given two times daily for 5 days.
p.21
Management of Respiratory Infections
What should be done to stop convulsions in a child?
Give Diazepam and turn the child to their side.
p.21
Management of Respiratory Infections
What should be done if convulsions do not stop after 10 minutes?
Repeat the Diazepam dose.
p.6
Management of Respiratory Infections
What treatment should be given for pneumonia classified as yellow?
Give oral Amoxicillin for 5 days.
p.19
Home Care and Treatment Instructions for Parents
How long should gentian violet be used after mouth ulcers have healed?
For 48 hours after the ulcers have been cured.
p.14
HIV Testing and Management in Children
What should be done for HIV exposed children less than 18 months if PCR tests are not available?
Use the HIV antibody test; a positive result indicates exposure but not necessarily infection.
p.21
Management of Respiratory Infections
What type of injection should be given for the medication?
Give the drug as an intramuscular injection.
p.21
Management of Respiratory Infections
What should be done if the child cannot be referred?
Follow the provided instructions for treatment.
p.10
Nutritional Assessment and Management of Malnutrition
What is the purpose of MUAC in assessing malnutrition?
To measure Mid-Upper Arm Circumference in children 6 months or older.
p.16
Assessment and Classification of Common Childhood Illnesses
What is the dosage of Ciprofloxacine for a child less than 6 months?
1/2 of a 250 mg tablet, given two times daily for 3 days.
p.21
Management of Respiratory Infections
What should be done if referral is not possible for Artesunate?
Give the first dose of Artesunate intramuscularly and repeat after 12 hours.
p.6
Management of Respiratory Infections
What should be done if a child shows general danger signs or stridor in a calm child?
Classify as severe pneumonia or very severe disease, give first dose of an appropriate antibiotic, and refer urgently to hospital.
p.21
Management of Respiratory Infections
What treatments should be given for severe malaria?
Give Artesunate suppositories, intramuscular Artesunate, or Quinine.
p.6
Assessment and Classification of Common Childhood Illnesses
What is classified as fast breathing for a child aged 2 months to 12 months?
50 breaths per minute or more.
